How to ease a somersaulting stomach

Paula Radcliffe competes in the half-marathon challenge of the Vienna City Marathon in 2012. Seven years earlier, Radcliffe suffered a public embarrassment during the London Marathon when her digestive system forced her to make a stop.Photo by
Dieter Nagl

It’s far from a topic for dinner conversation, but almost every runner has a story to tell about an emergency bathroom break during a run.

For some, it’s a one-off experience, most likely the result of bad timing or bad food. For others, planning a route around available bathrooms is a must.

Often referred to as the runner’s trots, exercise-related gastrointestinal complaints aren’t limited to runners, nor are they all solved by a little private time. Heartburn, nausea and vomiting can also be induced by exercise.

The polling of participants at marathons and other athletic events has led to estimates that 30 to 90 per cent of athletes have experienced some kind of gastrointestinal distress while exercising.

Sometimes it’s stomach pains from swallowing too much air while chugging from a water bottle, and sometimes it’s full-blown diarrhea, the likes of which caused British marathoner Paula Radcliffe to pull off to the side of the road during the 2005 London Marathon to relieve her distress — in full view of spectators and captured by the media.

Far from being shocked, most marathoners consider themselves lucky if they make it to the finish line without experiencing some sort of gastrointestinal issue.

The problem is so prevalent that American marathon legend Bill Rodgers famously stated that “more marathons are won or lost in the portable toilets than at the dinner table.”

What’s the reason behind all this tummy trouble? There are several likely culprits.

One of the factors is a shifting of the blood supply from the internal organs to the working muscles, which occurs as exercise intensity and duration increases. This negatively affects the workings of the gut, which is why so many endurance athletes experience an upset stomach, diarrhea, nausea or vomiting during training or competition.

Another cause of gastrointestinal distress is the jostling of the stomach that occurs with every footfall, which over time can cause just enough micro trauma to result in an urgent search for the nearest bathroom.

Cyclists are also frequent victims of stomach woes, especially triathletes who hunch over in an extreme aerodynamic position, creating extra pressure on the abdomen. This can be exacerbated by inhaling too much air while drinking from a water bottle and then resuming the position.

Heat can make things worse, too, as excess sweating can cause just enough dehydration to mess up the works. Add the stress associated with competition, and the porta-potties along marathon routes get quite the workout.

Then there are dietary issues, which further increase the chances of gastrointestinal problems when combined with the physiological changes that occur during a long, tough workout.

Foods that are high in fibre are obvious culprits, and should be avoided in the days and hours leading up to an intense competition or workout. Other triggers include products containing lactose, which is why some athletes stick to soy or lactose-free beverages on race day.

Distance athletes who consume calories during competition are also more susceptible to an upset stomach. Particularly at fault are highly concentrated carbohydrate solutions, gels and liquids. Fortunately, some of the discomfort dissipates when you have more experience snacking during a workout. Some of that improvement involves your body learning to do a better job at tolerating energy drinks or gels, and some of it is due to experimenting with carbohydrate concentrations and other products until you find one that settles well in the stomach.

Finding just the right pre-race diet and products tolerable for ingestion during competition takes time, but once they’re found, they should be adhered to without fail. Don’t do what a friend did while running a marathon in her native Finland. Tempted by the raisins and salted cod available at fuelling stations, she consumed something unfamiliar along the race route. She paid for it by going from porta-potty to porta-potty until she had nothing left to give — an experience that should serve as a caution to marathoners who travel all over the world to compete.

The use of non-steroidal anti-inflammatory drugs like Tylenol before or during a race can also cause problems. A common practice to ward off race-day aches and pains, it may contribute to heartburn, stomach ache and diarrhea.

For those who suffer from heartburn or gastric reflux during a race or workout, extending the time between the evening meal and bedtime to four or more hours and avoiding chocolate, peppermint, onions, high-fat foods, alcohol, tobacco, coffee and citrus before a tough workout is recommended.

Of course, there are those with guts of steel who have never had to pull a Paula Radcliffe at the side of the road or struggle to finish 42 kilometres while dealing with heartburn or nausea.

But if the number of exercise-related gastrointestinal complaints is indeed as high as estimated, the majority of athletes can benefit from an ounce of prevention and avoid the discomfort and embarrassment of an emergency stop.

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